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Hospice nurse shares what happens to the body after death

A hospice nurse has revealed the reality of what happens to our bodies in the minutes, hours and days after we die. In her efforts to break down the taboo around conversations about death, Julie McFadden, a hospice nurse from the US, posts candid videos about death and dying to help us be more informed and prepared. In Julie’s latest video, she explains exactly what happens to the human body in the moments, hours and days after someone dies. Nurse Julie said that in the immediate moments after death, the body completely relaxes, beginning the first stage of decomposition, called hypostasis. “All of the things in your body that are holding fluids in, relaxes. That's why death can be messy sometimes.” She clarified that because of how relaxed the body becomes, those who have just died may urinate, have bowel movements or experience bodily fluids coming out of their nose, mouth, ears or eyes. Nurse Julie added, “I like to talk about it so people aren't surprised if that happens - very normal and to be expected sometimes.” This is also when the stage of decomposition called autolysis, or “the self-digestion” stage, occurs and enzymes begin to break down oxygen-deprived tissue, also causing the body temperature to drop. As the body settles in the hours after death, Nurse Julie said the blood will begin to pool downward toward the ground. She said, “If you let someone lie there for long enough - which we do sometimes; you don't have to hurry up and make sure your loved one leaves the house - if you turn them you will notice usually the back of their legs the whole backside of them will look purple or darker that's because all their blood is pulling down.” “Gravity is pulling it down. So they will eventually get a darker colour tone of skin on their backside.” One to two hours after death is also when rigor mortis - or the stiffening of a body’s muscles - sets in and continues for about the next 24 hours Nurse Julie said, “I have seen people become very stiff almost immediately - like a few minutes - after death and other people, their body takes longer.” Additionally, about 12 hours after death, the body will feel cool to the touch. About a day to a day and a half after a person dies, rigor mortis subsides and the body will begin to loosen again, as Nurse Julie said the body's tissues relax and cause the stiffness to break down. By this time, the body is usually in the mortuary, which will prepare the body in whichever way the family has requested, whether it is for burial or cremation. She added, “In a world where people didn't have access to a mortuary or a healthcare system and they just died naturally, our bodies are built to, after death, decompose.” Image credits: Shutterstock / Instagram / YouTube

Body

Hospice nurse shares the four physical stages of dying

A hospice nurse has shared the four things that happen to your body in the months, weeks and days before you die. Julie McFadden, who specialises in end of life care, shares videos about death and dying on social media to open up the conversation on the taboo topic, to help better prepare people for death. In her latest video, a viewer asked Julie what the dying process actually looks like, as the nurse explained that it all depends on how, when and why you pass away. However, she said there are four things that happen to the body as the end draws near. The first stage of dying is slowing down, which can happen up to six months before you die, with the symptoms being very "generalised". Julie says, "For instance, you’re just going to be generally tired, generally lethargic, not eating and drinking as much, probably being less social." According to Julie, the second stage is a sharp decline in strength, as she explains, "The closer you get to death – let’s say three months out – you’re going to be more debilitated." "It’s going to be difficult for you to leave the house, you probably are eating and drinking very little throughout the day, and you’re sleeping more than you’re awake." <p style="font-size: 1rem; border: 0px; font-stretch: inherit; line-height: 1.375rem; font-family: -apple-system, system-ui, BlinkMacSystemFont, 'Segoe UI', Roboto, 'Helvetica Neue', Arial, sans-serif; font-size-adjust: inherit; font-kerning: inherit; font-variant-alternates: inherit; font-variant-ligatures: inherit; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-variant-position: inherit; font-feature-settings: inherit; font-optical-sizing: inherit; font-variation-settings: inherit; margin: 0px 0px 1.4rem; padding: 0px; vertical-align: baseline;">Before the last stage of life, Julie describes a period of "transitioning" which happens around a month before death and can include a phenomenon known as "visioning". <p style="font-size: 1rem; border: 0px; font-stretch: inherit; line-height: 1.375rem; font-family: -apple-system, system-ui, BlinkMacSystemFont, 'Segoe UI', Roboto, 'Helvetica Neue', Arial, sans-serif; font-size-adjust: inherit; font-kerning: inherit; font-variant-alternates: inherit; font-variant-ligatures: inherit; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-variant-position: inherit; font-feature-settings: inherit; font-optical-sizing: inherit; font-variation-settings: inherit; margin: 0px 0px 1.4rem; padding: 0px; vertical-align: baseline;">The nurse says, "This is when people will start seeing dead relatives, dead loved ones, dead pets, things like that." She says that typically, someone "can be up and having a normal conversation with their family", all the while "saying they’re seeing their dead father in the corner who is smiling and telling them he’s coming to get them soon and not to worry." <p style="font-size: 1rem; border: 0px; font-stretch: inherit; line-height: 1.375rem; font-family: -apple-system, system-ui, BlinkMacSystemFont, 'Segoe UI', Roboto, 'Helvetica Neue', Arial, sans-serif; font-size-adjust: inherit; font-kerning: inherit; font-variant-alternates: inherit; font-variant-ligatures: inherit; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-variant-position: inherit; font-feature-settings: inherit; font-optical-sizing: inherit; font-variation-settings: inherit; margin: 0px 0px 1.4rem; padding: 0px; vertical-align: baseline;">According to Julie, this final stage of death is considered the most "distinct time in the dying process" when the body starts to fully shut down. <p style="font-size: 1rem; border: 0px; font-stretch: inherit; line-height: 1.375rem; font-family: -apple-system, system-ui, BlinkMacSystemFont, 'Segoe UI', Roboto, 'Helvetica Neue', Arial, sans-serif; font-size-adjust: inherit; font-kerning: inherit; font-variant-alternates: inherit; font-variant-ligatures: inherit; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-variant-position: inherit; font-feature-settings: inherit; font-optical-sizing: inherit; font-variation-settings: inherit; margin: 0px 0px 1.4rem; padding: 0px; vertical-align: baseline;">"The actively dying phase is what scares people, because they’re not used to seeing it and they don’t know what the heck’s going on," she says. <p style="font-size: 1rem; border: 0px; font-stretch: inherit; line-height: 1.375rem; font-family: -apple-system, system-ui, BlinkMacSystemFont, 'Segoe UI', Roboto, 'Helvetica Neue', Arial, sans-serif; font-size-adjust: inherit; font-kerning: inherit; font-variant-alternates: inherit; font-variant-ligatures: inherit; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-variant-position: inherit; font-feature-settings: inherit; font-optical-sizing: inherit; font-variation-settings: inherit; margin: 0px 0px 1.4rem; padding: 0px; vertical-align: baseline;">‘Metabolic changes’ such as a difference in skin colour, high and low temperature, or the ‘death rattle’ – a gurgling noise (also known as terminal secretions) caused by a buildup of fluids in the throat and upper airways – follow before they later pass on. <p style="font-size: 1rem; border: 0px; font-stretch: inherit; line-height: 1.375rem; font-family: -apple-system, system-ui, BlinkMacSystemFont, 'Segoe UI', Roboto, 'Helvetica Neue', Arial, sans-serif; font-size-adjust: inherit; font-kerning: inherit; font-variant-alternates: inherit; font-variant-ligatures: inherit; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-variant-position: inherit; font-feature-settings: inherit; font-optical-sizing: inherit; font-variation-settings: inherit; margin: 0px 0px 1.4rem; padding: 0px; vertical-align: baseline;">However, while it’s natural to find these things upsetting, Julie assures people this stage is a "normal part of death and dying", and "it’s not hurting your loved one." "It’s important to be educated about what death actually looks like. Movies and television don’t do it justice, then people see it in real life when it’s their loved ones and they freak out," she said. <p style="font-size: 1rem; border: 0px; font-stretch: inherit; line-height: 1.375rem; font-family: -apple-system, system-ui, BlinkMacSystemFont, 'Segoe UI', Roboto, 'Helvetica Neue', Arial, sans-serif; font-size-adjust: inherit; font-kerning: inherit; font-variant-alternates: inherit; font-variant-ligatures: inherit; font-variant-numeric: inherit; font-variant-east-asian: inherit; font-variant-position: inherit; font-feature-settings: inherit; font-optical-sizing: inherit; font-variation-settings: inherit; margin: 0px 0px 1.4rem; padding: 0px; vertical-align: baseline;">Image credits: YouTube / Instagram

Caring

Hospice nurse reveals the key to a peaceful death

Hospice nurse Julie McFadden has shared her best advice for ensuring a peaceful death, after learning from her patients in their final moments. The healthcare professional, who is known for her YouTube channel where she shares information about death to break the taboo of conversations around dying, shared a video about what you can do in life to ensure a peaceful passing. In the recent clip, she shared what you can do in order to have a peaceful death, and she says it comes down to preparedness and acceptance. "That's one of the biggest things I see," she explained. "People who plan for death will tend to have a more peaceful death than those who do not plan for death." "A prepared death versus a non-prepared death - that's the one thing that I've seen in all of my patients," she explained. Julie said she noticed the patients that were "willing to talk about the hard stuff" had a more peaceful death. <iframe title="YouTube video player" src="https://www.youtube.com/embed/qoFvKkfIo00?si=Ba5BnxuaKsBVaGAe" width="560" height="315" frameborder="0" allowfullscreen="allowfullscreen"></iframe> "[That means] willing to ask the questions about, 'how long do you think I have? What can I expect? What should I do before I die to make this easier for my family?'" she listed. Julie went on to share a story of when a patient of hers died peacefully surrounded by his family, explaining that the patient was in hospice and had started to decline around 20 minutes after she arrived. "He started having weird changes in breathing, so this was a sudden decline and it looked like he may suddenly die," she recalled, adding the abrupt change was "uncommon actually" in hospice care. "What I noticed was because this family - and him - were so prepared, instead of the family [being] chaotic and reacting in an emotional way - which is very normal - they flipped along right with him," she explained. "[They laid] in bed with him. They understood immediately what was happening. They didn't panic," she shared. Julie said the man was surrounded by his loving family and it was an overwhelmingly emotional experience. "It makes me cry every time I think about it - that vision of them all being able to understand what was happening, even though it was a change they didn't want," she explained. "By the end of that visit he died, so he went from kind of looking okay to dying which is hard - but that family made it a beautiful moment," she said. Image credits: YouTube

Caring

What happens if you want access to voluntary assisted dying but your nursing home won’t let you?

<div class="theconversation-article-body"> <a href="https://theconversation.com/profiles/neera-bhatia-15189">Neera Bhatia</a>, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a> and <a href="https://theconversation.com/profiles/charles-corke-167297">Charles Corke</a>, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a> Voluntary assisted dying is now lawful in <a href="https://theconversation.com/voluntary-assisted-dying-will-soon-be-legal-in-all-states-heres-whats-just-happened-in-nsw-and-what-it-means-for-you-183355">all Australian states</a>. There is also <a href="https://nationalseniors.com.au/uploads/VAD-Report-correct-month-12.8.21.pdf">widespread community support</a> for it. Yet some residential institutions, such as hospices and aged-care facilities, are obstructing access despite the law not specifying whether they have the legal right to do so. As voluntary assisted dying is implemented across the country, institutions blocking access to it will likely become more of an issue. So addressing this will help everyone – institutions, staff, families and, most importantly, people dying in institutions who wish to have control of their end. <h2>The many ways to block access</h2> While voluntary assisted dying legislation recognises the right of doctors to <a href="https://theconversation.com/was-take-on-assisted-dying-has-many-similarities-with-the-victorian-law-and-some-important-differences-121554">conscientiously object</a> to it, the law is generally silent on the rights of institutions to do so. While the institution where someone lives has no legislated role in voluntary assisted dying, it can refuse access in various ways, including: <ul> <li> restricting staff responding to a discussion a resident initiates about voluntary assisted dying </li> <li> refusing access to health professionals to facilitate it, and </li> <li> requiring people who wish to pursue the option to leave the facility. </li> </ul> <h2>Here’s what happened to ‘Mary’</h2> Here is a hypothetical example based on cases one of us (Charles Corke) has learned of via his role at Victoria’s <a href="https://www.safercare.vic.gov.au/about/vadrb">Voluntary Assisted Dying Review Board</a>. We have chosen to combine several different cases into one, to respect the confidentiality of the individuals and organisations involved. “Mary” was a 72-year-old widow who moved into a private aged-care facility when she could no longer manage independently in her own home due to advanced lung disease. While her intellect remained intact, she accepted she had reached a stage at which she needed significant assistance. She appreciated the help she received. She liked the staff and they liked her. After a year in the facility, during which time her lung disease got much worse, Mary decided she wanted access to voluntary assisted dying. Her children were supportive, particularly as this desire was consistent with Mary’s longstanding views. Mary was open about her wish with the nursing home staff she felt were her friends. The executive management of the nursing home heard of her intentions. This resulted in a visit at which Mary was told, in no uncertain terms, her wish to access voluntary assisted dying would not be allowed. She would be required to move out, unless she agreed to change her mind. Mary was upset. Her family was furious. She really didn’t want to move, but really wanted to continue with voluntary assisted dying “in her current home” (as she saw it). Mary decided to continue with her wish. Her family took her to see two doctors registered to provide assessments for voluntary assisted dying, who didn’t work at the facility. Mary was deemed eligible and the permit was granted. Two pharmacists visited Mary at the nursing home, gave her the medication and instructed her how to mix it and take it. These actions required no active participation from the nursing home or its staff. Family and friends arranged to visit at the time Mary indicated she planned to take the medication. She died peacefully, on her own terms, as she wished. The family informed the nursing home staff their mother had died. Neither family nor staff mentioned voluntary assisted dying. <h2>Staff are in a difficult position too</h2> There is widespread community support for voluntary assisted dying. In a 2021 survey by National Seniors Australia, <a href="https://nationalseniors.com.au/uploads/VAD-Report-correct-month-12.8.21.pdf">more than 85%</a> of seniors agreed it should be available. So it’s likely there will be staff who are supportive in most institutions. For instance, in a survey of attitudes to voluntary assisted dying in a large public tertiary hospital, <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/imj.15285">88% of staff</a> supported it becoming lawful. So a blanket policy to refuse dying patients access to voluntary assisted dying is likely to place staff in a difficult position. An institution risks creating a toxic workplace culture, in which clandestine communication and fear become entrenched. <h2>What could we do better?</h2> 1. Institutions need to be up-front about their policies Institutions need to be completely open about their policies on voluntary assisted dying and whether they would obstruct any such request in the future. This is so patients and families can factor this into deciding on an institution in the first place. 2. Institutions need to consult their stakeholders Institutions should consult their stakeholders about their policy with a view to creating a “<a href="https://bmcpalliatcare.biomedcentral.com/articles/10.1186/s12904-021-00891-3">safe</a>” environment for residents and staff – for those who want access to voluntary assisted dying or who wish to support it, and for those who don’t want it and find it confronting. 3. Laws need to change Future legislation should define the extent of an institution’s right to obstruct a resident’s right to access voluntary assisted dying. There should be safeguards in all states (as is already legislated <a href="https://documents.parliament.qld.gov.au/tp/2021/5721T707.pdf">in Queensland</a>), including the ability for individuals to be referred in sufficient time to another institution, should they wish to access voluntary assisted dying. Other states should consider whether it is reasonable to permit a resident, who does not wish to move, to be able to stay and proceed with their wish, without direct involvement of the institution. <hr /> The opinions expressed in this article are those of the authors and do not necessarily reflect the views of Victoria’s Voluntary Assisted Dying Review Board.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/183364/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/neera-bhatia-15189">Neera Bhatia</a>, Associate Professor in Law, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a> and <a href="https://theconversation.com/profiles/charles-corke-167297">Charles Corke</a>, Associate Professor of Medicine, <a href="https://theconversation.com/institutions/deakin-university-757">Deakin University</a> Image credits: Shutterstock This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/what-happens-if-you-want-access-to-voluntary-assisted-dying-but-your-nursing-home-wont-let-you-183364">original article</a>. </div>

Caring

Hospice nurse reveals six unexplainable "death bed phenomena"

Hospice nurse Julie McFadden has lifted the lid on six unexplainable "death bed phenomena" that occur within a person's last weeks of life. The LA-based nurse, who specialises in end of life care, explained that as a person nears the end of their life, they will experience a range of unusual things, including hallucinations, random bursts of energy and even choosing when they're going to die. McFadden once again took to her YouTube channel to educate people on what happens when you're on your death bed, detailing each of the six strange occurrences. Julie explained that patients often experienced "terminal lucidity", "hallucinations", "death stares", and more in their final weeks. She began by explaining the first wild thing that happened at the end of life was terminal lucidity, in which people get a "burst of energy" in the days before they die, sharing that it happens "very often". She said, "Just enjoy it and expect that maybe they will die soon after because that's the kicker with terminal lucidity, it looks like someone's going to die very soon then suddenly they have a burst of energy." "They maybe have a really great day, they're suddenly hungry, they're suddenly able to walk, they're suddenly very alert and oriented, and then shortly after usually a day or two they will die, so that can be the hard part if you're not ready for it, if you don't know what's coming you can think they're getting better and then they die, which can be very devastating." Julie then described how most people in their final days will encounter "death visioning" or "hallucinations", as many people describe seeing the ghosts of loved ones in their final days. "I wouldn't have believed it unless I saw it for myself over and over again," the nurse admitted. "Number three, this is really crazy - people choosing when they're going to die. I have seen some extreme cases of this, people just saying, 'Tonight's when I'm going to die I know it, I can feel it,' and they do. There's also a time when people will wait for everybody to get into town or get into the room arrive at the house whatever it is and then they will die," the nurse explained. The fourth phenomena is known as the "death reach", according to Julie. She explained, "It's when the person's lying in bed and they reach up in the air like they're seeing someone or they're reaching for someone either to hug them or to shake their hands. A lot of times they'll hold their hands up for a long time, like they're seeing something that we're not seeing and they're reaching for someone that we can't see." Julie then listed "number five is the death stare," explaining that the death stare and the death reach often "go together". "It usually looks like someone is staring off into the corner of the room or the side of the room basically looking at something intently, but if you're snapping your finger in front of their face or trying to say their name to kind of snap them out of it, they won't," she said. The last wild thing the nurse has seen is known as a "shared death experience" and is "most impactful", according to Julie. She explained, "A shared death experience is when someone who is not dying feels or sees or understands what's happening to the person who is dying." "It's kind of like the dying person gives you the sensation of what they're going through. From what I experienced, it was a very good feeling. It was like the person was giving me these feelings of freedom and joy and kind of telling me that they were okay." "At the time, I was shocked, I didn't know what was happening, but I've come to find out that that's called a shared death experience." Image credits: YouTube / Instagram

Caring

Hospice nurse explains why we shouldn't be afraid to die

A hospice nurse has shared why we shouldn't be afraid to die, explaining all the ways in which our bodies "shut off" to make for a "peaceful" death. Julie McFadden, a nurse based in Los Angeles, has long been sharing videos and explanations about end of life care in an attempt to destigmatise the conversations and fear around death and dying. In her latest YouTube video, McFadden got candid with her followers as she confessed she isn't afraid to die and why no one else should be either. She went on to explain all the ways in which our bodies are supposed to "shut off" in our final moments, making for a "peaceful" and "natural" death. " "I'm not afraid of death and here's the science behind it, our body biologically helps us die, so here is what I've seen and learned as a hospice nurse over the years - our body is literally built to die," she said. The hospice nurse revealed that bodies began to slowly shut down in the six months leading up to death, explaining that a person nearing the end of their life would start "eating less, drinking less, and sleeping more." "Why is that happening? Because calcium levels in the body are going up and because calcium levels are going up the person is getting sleepier," Julie said. "Our brains have built in mechanisms to make us hungry and thirsty. Biologically, when the body knows it's getting towards the end of life those mechanisms shut off, so the person does not usually feel hungry and does not usually feel thirsty, which is helping the body slowly shut down." <iframe title="YouTube video player" src="https://www.youtube.com/embed/CJEkzA0gt6s?si=CIzcf3xchddKtf1D" width="560" height="315" frameborder="0" allowfullscreen="allowfullscreen"></iframe> She put minds at ease by debunking a common concern, saying that while certain diseases could make death more uncomfortable, dying in itself wasn't painful. "There are times when the disease that the person is experiencing can cause symptoms and it's more difficult because they're dying from a certain disease, but the actual process that the body is going through to help it die is actually helping that person," Julie added. "There have been many times as a hospice nurse that I have watched someone slowly die on hospice and I have not needed to give them any medication because their disease was not causing any symptoms - no pain, no shortness of breath, they were just more tired and weren't eating or drinking." "They still did all of the things any other person on hospice would be doing, like they slowly go unconscious, they slowly stop eating and drinking. I didn't have to give them any medications. They were perfectly comfortable and died a very peaceful death." Julie explained that death was even "comforting" in a way because when you're about to take your last breath, your body released endorphins, making you feel euphoric in your final moments. "The body slowly goes into something called ketosis, which releases endorphins. In that person's body those endorphins dull pain, dull nerves, and they also give that person a euphoric sense, so they feel good," she said. "There are many reasons why I don't fear death. Yes, I have had some pretty crazy spiritual experiences as a hospice nurse that led me to not fear death, but there are also biological, metabolical, and physiological things that happen in the body that truly, truly comforted me." She concluded, "Our bodies are built to die. The less we mess with that, the more peaceful it will be." Image credits: YouTube / Instagram

Caring

Life behind bars for serial killer nurse

British nurse Lucy Letby has been handed a life sentence for the murder of seven infants and the attempted murder of six others in a neonatal ward located in Chester, England. Justice James Goss, adhering to the strictest punishment allowed by British law, issued a whole-life order, ensuring that 33-year-old Letby would spend the remainder of her life incarcerated, as capital punishment is not applicable in the UK. In a trial that spanned ten months, Letby was found guilty of killing five male and two female infants and causing harm to other newborns within the neonatal unit of the Countess of Chester Hospital between June 2015 and June 2016. This conviction ranks her among the most prolific child serial killers in the UK's history. Despite her absence from the sentencing proceedings, Justice Goss emphasised the calculated nature of Letby's actions, stating, "There was premeditation, calculation and cunning." He further highlighted the malevolence and absence of remorse in her demeanour, emphasising that no mitigating factors were present. Prosecutors detailed Letby's disturbing actions during her tenure in the neonatal unit. As the hospital witnessed an alarming increase in unexplained infant deaths and health deteriorations, Letby was consistently on duty during these incidents. Prosecutors painted her as a constant, ominous presence when these infants experienced collapses or fatalities, using tactics that were difficult to detect. She even deceived colleagues into believing these incidents were normal. The anguish and outrage from the victims' families were palpable during the sentencing, compounded by Letby's absence from the proceedings, which is permitted under British legal protocol. The mother of a girl identified as Child I said in a statement read in court: "I don’t think we will ever get over the fact that our daughter was tortured till she had no fight left in her and everything she went through over her short life was deliberately done by someone who was supposed to protect her and help her come home where she belonged." Because of Letby's absence at the sentencing, calls for legal reform quickly emerged, urging that prisoners should be compelled to attend their sentencings. UK Prime Minister Rishi Sunak expressed his government's intention to address this matter. Medical professionals raised concerns about Letby's behaviour as early as 2015, but their apprehensions were not heeded by management. Some argue that had these concerns been acted upon promptly, lives could have been saved. An independent inquiry will delve into the hospital's response to the alarming rise in deaths and the actions of the staff and management. In conclusion, British nurse Lucy Letby's life sentence for the murder of seven babies and the attempted murder of six others has sent shockwaves through the nation. Her calculated actions, lack of remorse, and absence from the sentencing have ignited discussions about legal reforms and the responsibility of institutions to heed early warning signs. Images: Cheshire Constabulary

Legal

Lump sum, daily payments or a combination? What to consider when paying for nursing home accommodation

<a href="https://theconversation.com/profiles/anam-bilgrami-1179543">Anam Bilgrami</a>, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a> Moving yourself or a loved one to a nursing home can be <a href="https://theconversation.com/should-we-move-our-loved-one-with-dementia-into-a-nursing-home-6-things-to-consider-when-making-this-tough-decision-189770">emotional and difficult</a>. While some have their nursing home accommodation costs fully covered by the government (based on a <a href="https://www.myagedcare.gov.au/how-much-will-i-pay">means test</a>), most will have to pay their own way. The average lump sum room value is <a href="https://www.health.gov.au/sites/default/files/documents/2021/08/ninth-report-on-the-funding-and-financing-of-the-aged-care-industry-july-2021.pdf">A$334,000</a>. Choosing how to pay can make this time even more challenging, particularly for those with <a href="https://theconversation.com/would-you-pass-this-financial-literacy-quiz-many-wont-and-its-affecting-expensive-aged-care-decisions-175063">low financial literacy</a>. This is an important and complex decision. It can affect your income, wealth, means-tested aged care fee, and bequests. Here are some things to consider before you decide. <h2>3 ways to pay</h2> You can <a href="https://www.myagedcare.gov.au/understanding-aged-care-home-accommodation-costs">pay</a> for a nursing home room in three ways. You can pay the entire room price as a one-off, refundable lump sum (a “refundable accommodation deposit”, sometimes shortened to RAD). This lump sum is refunded to the resident or their estate when the person leaves the nursing home (if they move or pass away). The refund is <a href="https://www.myagedcare.gov.au/aged-care-home-accommodation-refunds">guaranteed by the government</a>, even if a provider goes bankrupt. People who don’t want to pay a lump sum can instead choose rent-style, “daily accommodation payments” (sometimes shortened to DAP). These are fixed, daily interest-only payments calculated on the total room price. The rate at which they are calculated is known as the “maximum permissible interest rate” or MPIR. The maximum permissible interest rate is set by the government and is currently <a href="https://www.health.gov.au/sites/default/files/2023-06/base-interest-rate-bir-and-maximum-permissible-interest-rate-mpir-for-residential-aged-care_0.pdf">7.9%</a> per annum. The <a href="https://www.health.gov.au/our-work/residential-aged-care/managing-residential-aged-care-services/managing-accommodation-payments-and-contributions-for-residential-aged-care#accommodation-payment">formula</a> for a daily accommodation payment is (RAD × MPIR) ÷ 365. Unlike lump sums, daily accommodation payments are not refunded. The third option is a <a href="https://www.health.gov.au/our-work/residential-aged-care/managing-residential-aged-care-services/managing-accommodation-payments-and-contributions-for-residential-aged-care#accommodation-payment">combination payment</a>. This means paying part of the room price as a lump sum, with daily payments calculated on the remaining room amount. On leaving the home, the part lump sum is refunded to the resident or their estate. With a combination payment, the consumer can choose to pay whatever amount they like for the lump sum. The table below shows three different ways someone could pay for a room priced at $400,000. <figure class="align-center zoomable"><a href="https://images.theconversation.com/files/540310/original/file-20230731-130241-shaphm.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/540310/original/file-20230731-130241-shaphm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px" srcset="https://images.theconversation.com/files/540310/original/file-20230731-130241-shaphm.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=432&fit=crop&dpr=1 600w, https://images.theconversation.com/files/540310/original/file-20230731-130241-shaphm.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=432&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/540310/original/file-20230731-130241-shaphm.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=432&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/540310/original/file-20230731-130241-shaphm.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=542&fit=crop&dpr=1 754w, https://images.theconversation.com/files/540310/original/file-20230731-130241-shaphm.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=542&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/540310/original/file-20230731-130241-shaphm.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=542&fit=crop&dpr=3 2262w" alt="" /></a><figcaption><a class="license" href="http://creativecommons.org/licenses/by/4.0/">CC BY</a></figcaption></figure> So which is best? It’s impossible to say. It depends on a person’s circumstances, family situation, finances, preferences and expected length of stay. <h2>Why do some people choose a lump sum?</h2> One downside of a lump sum (or part lump sum) is that choosing this option means this money is not invested elsewhere. By handing over the lump sum, for example, you forgo returns you could have made by investing this same money into property or stocks over the period of your nursing home stay. On the other hand, paying lump sum means you get to avoid the daily interest payments (the 7.9% in the table above). So you could potentially be better off paying a lump sum if you think there’s no way you could make investment returns on that money that are substantially higher than the interest you’d be charged through daily payments. One advantage of choosing a lump sum is it’s considered an <a href="https://www.dva.gov.au/get-support/health-support/care-home-or-aged-care/help-pay-home-or-aged-care/residential-aged-0">exempt asset</a> for pension purposes; some people may get more <a href="https://www.afr.com/wealth/personal-finance/five-things-you-need-to-know-about-aged-care-deposits-20200302-p54606">pension</a> if they pay the lump sum. The lump sum, however, does count as an asset in determining the <a href="https://www.health.gov.au/our-work/residential-aged-care/charging-for-residential-aged-care-services/residential-aged-care-fee-scenarios-for-people-entering-care-from-1-july-2014">means-tested care fee</a>. And if you sell your house, remember any money leftover after you pay the lump sum will be counted as assets when you’re means-tested for the pension and means-tested care fee. <h2>Why might some people prefer daily payments?</h2> Not everyone can can afford a lump sum. Some may not want to <a href="https://theconversation.com/is-it-worth-selling-my-house-if-im-going-into-aged-care-161674">sell their home</a> to pay one. Some may want to hold onto their house if they think property prices may increase in the future. Daily payments have recently overtaken lump sums as the most <a href="https://www.health.gov.au/sites/default/files/documents/2021/08/ninth-report-on-the-funding-and-financing-of-the-aged-care-industry-july-2021.pdf">popular payment option</a>, with 43% of people paying this way. However, recent <a href="https://amp-smh-com-au.cdn.ampproject.org/c/s/amp.smh.com.au/money/super-and-retirement/aged-care-interest-rate-increase-sees-daily-payments-almost-double-20230324-p5cuz2.html">interest rate rises</a> may slow or reverse this trend. And if a spouse or “<a href="https://www.dva.gov.au/get-support/health-support/care-home-or-aged-care/residential-aged-care/aged-care-costs">protected person</a>” – such as a dependant or relative that meets certain criteria – is still living in the house, it’s also exempt from assets tests for the pension and other aged care fees. If the home is vacated by a protected person, its value is still excluded from the pension means test for <a href="https://www.dva.gov.au/get-support/health-support/care-home-or-aged-care/help-pay-home-or-aged-care/residential-aged-0">two years</a> (although rental income is still assessed). If you do not anticipate a lengthy nursing home stay, daily payments may potentially be the easiest option. But it’s best to consult a financial adviser. <h2>What does the research say?</h2> My <a href="https://www.mq.edu.au/__data/assets/pdf_file/0007/1190086/What-drives-end-of-life-financial-decisions.pdf">research</a> with colleagues found many people choose the lump sum option simply because they can afford to. Those <a href="https://ahes.org.au/portfolio-items/entering-aged-care/">owning residential property</a> are more likely to pay a lump sum, mostly because they can sell a house to get the money. People who consult financial advisers are also more likely to choose lump sums. This may be due to <a href="https://www.afr.com/wealth/aged-care-costs-most-opt-for-pay-as-you-go-20181023-h170g4">financial advice</a> suggesting it’s tough to earn investment returns higher than what you’d save by avoiding the interest charged in the daily payment option. Some aged care providers <a href="https://www.mq.edu.au/__data/assets/pdf_file/0003/1164243/the-role-of-refundable-accommodation-deposits-FINAL.pdf">prefer</a> lump sum payment since they <a href="https://www.agedcarequality.gov.au/providers/prudential-standards/permitted-use-refundable-deposits">use</a> these to renovate or refurbish their facilities. But providers are not allowed to influence or control your decision on how to pay. The recent Royal Commission into Aged Care recommended <a href="https://agedcare.royalcommission.gov.au/sites/default/files/2021-03/final-report-recommendations.pdf">phasing out</a> lump sums as a payment option, leaving only daily payments. While that would reduce the complexity of the payment decision and remove the incentive for providers to sway decisions, it would also reduce consumer choice. <h2>Is there anything else I should know?</h2> Some 60% of people we <a href="https://www.mq.edu.au/__data/assets/pdf_file/0007/1190086/What-drives-end-of-life-financial-decisions.pdf">surveyed</a> found the decision complex, while 54% said it was stressful. It is best to seek professional <a href="https://www.myagedcare.gov.au/understanding-aged-care-home-accommodation-costs#financial-advice">financial advice</a> before you decide. Services Australia also runs a free <a href="https://www.servicesaustralia.gov.au/what-financial-information-service?context=21836">Financial Information Service</a> that can help you better understand your finances and the payment decision. But it does not give <a href="https://www.servicesaustralia.gov.au/financial-information-service-officers?context=21836#a2">financial advice or prepare plans</a>. You have <a href="https://www.health.gov.au/our-work/residential-aged-care/managing-residential-aged-care-services/managing-accommodation-payments-and-contributions-for-residential-aged-care">28 days to choose a payment method</a> after admission, and six months to pay if you <a href="https://www.health.gov.au/our-work/residential-aged-care/managing-residential-aged-care-services/managing-accommodation-payments-and-contributions-for-residential-aged-care">choose a lump-sum payment</a>. In the interim, you will be charged daily interest payments on the room price.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important;" src="https://counter.theconversation.com/content/207405/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/anam-bilgrami-1179543">Anam Bilgrami</a>, Research Fellow, Macquarie University Centre for the Health Economy, <a href="https://theconversation.com/institutions/macquarie-university-1174">Macquarie University</a> Image credits: Getty Images This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/lump-sum-daily-payments-or-a-combination-what-to-consider-when-paying-for-nursing-home-accommodation-207405">original article</a>.

Retirement Life

Hospice nurse shares the specific things people see before they die

A hospice nurse has revealed the very specific things people often see before they die. Julie McFadden, a 39-year-old end of care nurse from Los Angeles, shared a now-viral TikTok about what people see in the moments before they pass away. Julie cares for terminally-ill patients near their end-of-life, keeping them comfortable in the months leading up to their death. In the final weeks of someone's life, people are often visited by lost loved ones and pets that give them the encouragement to cross over. The 39-year-old said most of her patients report apparitions of relatives who offer them comforting words such as, "We're coming to get you soon," or, "Don't worry, we'll help you". After working in hospice care for over five years, McFadden has learnt a lot about death and dying, and how people handle the last days of their life. She revealed that dying patients see family, friends and pets who have passed away so often it is noted in educational packets given to the patient and their relatives, "so they understand what's going on". McFadden also added that medical professionals don't know why these apparitions happen, and don't know how to explain it in a logical sense. These apparitions usually appear a month before the patient dies, she claims, and can either present in dreams or the person being able to physically see them. The nurse said patients will often ask, "Do you see what I'm seeing?" Rather than being scared of what they're seeing, Ms McFadden claims patients often find the visits "comforting". Julie went on to say that she doesn't believe these "visits" are hallucinations, as she says the patients are normally "pretty alert and oriented, they're usually lucid". "It's not like they're saying a bunch of crazy things that don't make any sense," Ms McFadden added. "They're usually functional and logical and questioning me, 'Why am I seeing my dead mom, do you see her?'" Ms McFadden ended her video by saying that for many people in their final days, these visits from loved ones can help a person feel a sense of calm and contentment around dying, rather than a sense of fear of the unknown. Image credits: Shutterstock / Instagram

Caring

Should we move our loved one with dementia into a nursing home? 6 things to consider when making this tough decision

Almost <a href="https://www.aihw.gov.au/reports/dementia/dementia-in-aus/contents/summary">400,000</a> Australians are living with dementia. A million or more family members and friends care for and support them. About two-thirds of people with dementia live in the community. Deciding to move a loved one into a nursing home is an incredibly difficult one. I found it difficult and stressful considering this move for my own loved one, even with 20 years of experience in dementia and aged care. Sometimes the decision has to be made quickly, such as when the person is in hospital. Sometimes the decision takes much longer and is made over months, or even years. There are some important things you should consider when trying to decide the best option for you and your loved one. I’ve outlined six here. <h2>1. Your loved ones’ views around going into care</h2> We don’t want to force our loved one to do something against their wishes. It’s unusual for someone to want to go into a nursing home. It may take many conversations and a decent amount of time before your loved one accepts they might need more care and that a nursing home is the right place to get that care. <h2>2. Your loved one’s current quality of life</h2> If you think your loved one has an overall good quality of life, and that their quality of life may decrease when they go into a nursing home, this could be a sign you should keep trying to support the person to live at home. However, if their quality of life is currently poor, particularly if this is due to not having enough day-to-day physical care, health care or emotional support, then moving into a nursing home might help meet their daily needs. Spend some time observing to figure out <a href="https://theconversation.com/home-for-the-holidays-and-worried-about-an-older-relative-make-observations-not-assumptions-173782">how your loved one is doing at home</a>. You could perhaps make a list of the things they need to lead a good life (company, three square meals, help taking medicines, going out into the community) and see if these are currently being met. <h2>3. Risks if your loved one stays at home</h2> People often <a href="https://bmcgeriatr.biomedcentral.com/articles/10.1186/1471-2318-7-13">go into a nursing home</a> because we think they are no longer safe living at home. It might be possible to reduce some of the risks of them being at home through <a href="https://www.enablingenvironments.com.au/home.html">modifying the home</a> and <a href="https://www.alzheimerswa.org.au/about-dementia/living-well-dementia/assistive-technology-help-sheets/">using technology</a>(personal emergency alarms, GPS trackers, stove timers) or services (meals on wheels, community care, physiotherapy for mobility). <h2>4. Capacity of your loved one’s family and friends to keep supporting them</h2> The availability and capacity of family carers is probably the most crucial part in supporting someone with dementia to keep living well at home. Carers often have other responsibilities such as work and children, which means they can’t support their loved one as much as they would like. Being a carer is physically and emotionally demanding, and over time caring can take its toll. Carers should seek help and support from other family and friends, learn more about <a href="https://forwardwithdementia.au/">dementia</a>, use services including <a href="https://theconversation.com/respite-care-can-give-carers-a-much-needed-break-but-many-find-accessing-it-difficult-183976">respite care</a> and <a href="https://www.dementia.org.au/support">Dementia Australia</a>. Carers often face a difficult choice between their own health and wellbeing, and supporting their loved one to remain at home. If carers are caring as much as their time, energy and physical and mental wellbeing will allow, and that care is not enough for their loved one’s needs, then more help is needed – and residential care is one way of getting that help. <h2>5. Alternatives to nursing home care</h2> Community care services are government-subsidised services to support older people to keep living at home. You can get up to 14 hours of care a week depending on need, though there is an assessment process and often a waiting time for services. You can pay for community care privately as well, although this can be very expensive. An <a href="https://www.cota.org.au/information/aged-care-navigators/who-can-use-aged-care-navigator-services/">Aged Care Navigator</a> (or from 2023 an “aged care finder”) can help you search for suitable available home care services. Some families choose to move in with the person with dementia, or have them move in with family. This may be an option if there is suitable accommodation, and they are able to live together comfortably. <h2>6. Availability of quality nursing home care</h2> It’s emotionally easier to place a loved one in a nursing home if carers are confident the home will provide suitable care. Often, family want a nursing home that is geographically close so they can visit, has a suitable room (such as a single room with an ensuite), sufficient and kind staff with training in supporting people with dementia, a pleasant environment, nutritious appealing food, and quality clinical care. It takes time to visit and pick a <a href="https://theconversation.com/when-choosing-a-nursing-home-check-the-clothing-and-laundry-100727">suitable nursing home</a>, check it’s appropriately <a href="https://theconversation.com/how-to-check-if-your-mum-or-dads-nursing-home-is-up-to-scratch-123449">accredited</a>, and understand how much it will <a href="https://theconversation.com/so-youre-thinking-of-going-into-a-nursing-home-heres-what-youll-have-to-pay-for-114295">cost</a>. You might have to wait for a bed in a quality home. You can often trial the nursing home by having your loved one stay for two weeks of respite care. When your loved one enters nursing home care, you’ll still be caring for them. You want to ensure you can continue to support your loved one emotionally and practically in partnership with the nursing home. <h2>Getting help</h2> Usually there is no “right” or “wrong” decision. You might struggle and there might be family conflict around what the “right” decision is. Speaking to a counsellor at <a href="https://www.dementia.org.au/support/counselling">Dementia Australia</a> might help work through the options and your feelings, you can talk to them as an individual or attend as a family. Image credits: Getty Images This article originally appeared on <a href="https://theconversation.com/should-we-move-our-loved-one-with-dementia-into-a-nursing-home-6-things-to-consider-when-making-this-tough-decision-189770" target="_blank" rel="noopener">The Conversation</a>.

Caring

Hospice nurse explains the “very comforting” thing that happens just before death

A hospice nurse has shared the “very comforting” thing that happens to a lot of people in the last moments of their life. Julie McFadden, a 39-year-old healthcare professional from the US, supports people who are coming to the end of their lives, going into specialised homes to make sure they remain as comfortable as possible in their final days. Throughout her career, she said more than half of those she has looked after experienced “visioning”, which is when people who are often fully lucid see deceased friends, family and pets in the moments leading up to death. “It happens most of the time at the end of their life, but they aren’t delusional,” the former intensive care nurse said on TikTok. “It’s often very comforting for the person. It’s never scary - if they’re scared, it’s likely they’re experiencing delirium or paranoia, not visioning.” “People don’t talk about it much but it’s really common and more than half of people I have looked after have experienced it.” “It’s so normal to fear death and I’ve had several patients who have expressed their fear - but then a family member came to them and they were no longer scared.” Julie went on to share a further explanation as to why people experience “visioning”, and the other-worldly power behind it. “We have no idea why this (visioning) happens and we are not claiming that they really are seeing these people,” she explained in one video. “We have no idea. But all I can tell you, as a healthcare professional who’s worked in this line of work for a very long time, (is that) it happens all the time.” “It happens so much that we actually have to educate the family and the patient about this topic before it happens so they’re not incredibly alarmed,” she added. “Usually it’s a good indicator that the person’s getting close to death - usually about a month or a few weeks before they die.” “It brings me comfort. I hope it brings you some comfort,” she concluded in her video, which quickly amassed more than 400,000 views. Image credits: TikTok

Caring

Could ‘virtual nurses’ be the answer to aged care staffing woes?

Former Health Department Chief Martin Bowles has <a href="https://www.theguardian.com/australia-news/2022/aug/03/virtual-nurses-may-be-needed-to-meet-247-aged-care-staff-mandate-top-health-executive-says" target="_blank" rel="noopener">reportedly proposed</a> “virtual nurses” could help address the shortage of nurses in aged care. This might involve remote, possibly artificial intelligence-assisted, virtual care, rather than physical nurse presence, to assist nursing homes to meet new legislative requirements to have a registered nurse present 24/7. There are clear opportunities for technological innovations to improve the care, health, and wellbeing of older people. However, substitution of face-to-face nursing and human interaction with remote care is not the answer. This seriously risks perpetuating the status quo where <a href="https://www.hrw.org/news/2021/03/03/australia-urgently-address-aged-care-abuse#:%7E:text=%E2%80%9CMultiple%20investigations%20and%20reports%20have,human%20rights%20of%20older%20people.%E2%80%9D" target="_blank" rel="noopener">many older people suffer</a> from isolation, neglect and lack of human engagement. Eroding requirements to properly staff nursing homes with registered nurses could make it even harder to <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8685779/" target="_blank" rel="noopener">attract and keep</a> staff. <h2>What are ‘virtual nurses’?</h2> “<a href="https://www.nature.com/articles/d41586-022-00072-z" target="_blank" rel="noopener">Robot nurses</a>” already exist in some contexts, helping to move patients, take vital signs (such as blood pressure), carry medicines and laundry, and even engage with patients. <blockquote class="twitter-tweet"> How Paro the robot seal is being used to help people w/<a href="https://twitter.com/hashtag/dementia?src=hash&ref_src=twsrc%5Etfw">#dementia</a> <a href="http://t.co/65GZPQdjb2">http://t.co/65GZPQdjb2</a> <a href="https://twitter.com/hashtag/caregiving?src=hash&ref_src=twsrc%5Etfw">#caregiving</a> <a href="https://twitter.com/hashtag/Alzheimers?src=hash&ref_src=twsrc%5Etfw">#Alzheimers</a> <a href="http://t.co/gXYztkNAJo">pic.twitter.com/gXYztkNAJo</a> — Ian Kremer (@LEAD_Coalition) <a href="https://twitter.com/LEAD_Coalition/status/602223483687317504?ref_src=twsrc%5Etfw">May 23, 2015</a></blockquote> However, “virtual nursing” likely refers to more familiar technology where a real nurse provides a limited range of care via <a href="https://www.sciencedirect.com/science/article/pii/S1541461219303866?casa_token=4QuZ-seF5i4AAAAA:0QtENxksLvBDzKsrvWXuPNcgrPcKf6XhaVTbOVJfsnE8nL-XVQypjCq9XZGXp_KJ51ekYUQn" target="_blank" rel="noopener">telehealth</a> (by phone and/or video). While some might appreciate when robots can assist with <a href="https://www.nursingworld.org/~494055/globalassets/innovation/robotics-and-the-impact-on-nursing-practice_print_12-2-2020-pdf-1.pdf" target="_blank" rel="noopener">certain tasks</a>, much of what nurses do cannot and should not be performed remotely (or by robots). Indeed, older people, their loved ones, and staff are <a href="https://www.theguardian.com/australia-news/2022/feb/05/yelling-out-for-help-the-atrocious-conditions-inside-australias-aged-care-homes" target="_blank" rel="noopener">calling out for</a> more physically present staff and more time to care and interact, not virtual interfaces and remote consultations. The benefits of technology in health care are unquestionable and many innovations have improved care for older people. Artificial intelligence shows promise in helping <a href="https://www.nature.com/articles/s41598-021-81115-9" target="_blank" rel="noopener">prevent and detect falls</a>, and socially assistive robots such as <a href="https://bmcgeriatr.biomedcentral.com/articles/10.1186/s12877-019-1244-6" target="_blank" rel="noopener">PARO</a> (a baby harp seal), have been shown to reduce stress, anxiety and antipsychotic use in people with dementia. Technology should not, however, be introduced at the <a href="https://www.sciencedirect.com/science/article/pii/S1322769620301438?via%3Dihub" target="_blank" rel="noopener">expense of care quality</a> or supporting and sustaining a suitably sized and skilled aged care workforce. We still need to adequately staff nursing homes to provide <a href="https://www.sciencedirect.com/science/article/pii/S0020748921000869?via%3Dihub" target="_blank" rel="noopener">safe, dignified care</a>. <h2>We need adequate staffing</h2> The <a href="https://agedcare.royalcommission.gov.au/publications/final-report" target="_blank" rel="noopener">Royal Commission into Aged Care Quality and Safety</a> heard a vast quantity of evidence regarding insufficient staffing, particularly of nurses who have the education and skills to deliver high quality clinical and personal care. This expertise is why nurses cannot be replaced with remote care, and why the Commission recommended 24/7 registered nurse presence; this has now been <a href="https://www.aph.gov.au/Parliamentary_Business/Bills_Legislation/Bills_Search_Results/Result?bId=r6874" target="_blank" rel="noopener">legislated</a>. More than half of Australian aged care residents live in nursing homes with <a href="https://ro.uow.edu.au/ahsri/1073/" target="_blank" rel="noopener">unacceptably low levels of staffing</a> and <a href="https://www.health.gov.au/resources/publications/2020-aged-care-workforce-census" target="_blank" rel="noopener">around 20%</a> do not have a registered nurse onsite overnight. Insufficient staffing results in workers <a href="https://www.anmfsa.org.au/Web/News/2022/The_grim_reality_of_what_happens_in_a_nursing_home_that_doesn_t_have_registered_nurses_24_7.aspx" target="_blank" rel="noopener">not having time to interact</a> with residents meaningfully and compassionately and also contributes to avoidable hospitalisations, worse quality care and outcomes, and poor working conditions for staff. As social beings, human interaction is <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3150158/" target="_blank" rel="noopener">fundamental to health</a>, wellbeing, and best practice care. This is particularly true for <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jan.12173?casa_token=l5Y_-r6rvt8AAAAA%3Awpp7P9Q9CUncyK60XOUPgv5ORx_Pi0jyMJ-Yp_kvdL7b5sTYih66Htp7l05J_I0vafKubec91hRL4Q" target="_blank" rel="noopener">older people in nursing homes</a> who are less able to engage with others and is especially vital for those living with <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/psyg.12765" target="_blank" rel="noopener">mobility challenges</a> and <a href="https://pubmed.ncbi.nlm.nih.gov/28332405/" target="_blank" rel="noopener">dementia</a>. Partly due to nurse low staffing levels, <a href="https://link.springer.com/article/10.1186/s12889-020-8251-6" target="_blank" rel="noopener">loneliness, isolation</a> and <a href="https://www.racgp.org.au/getattachment/86cf2c46-46f2-4177-a17b-700bb7cfa3ac/20030705lie.pdf" target="_blank" rel="noopener">mental ill health</a> are widespread in aged care and have become more common due to <a href="https://www.apa.org/topics/covid-19/nursing-home-residents" target="_blank" rel="noopener">pandemic related restrictions</a> on visitors and staff. Care experiences are shaped by <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6382052/" target="_blank" rel="noopener">human interaction and contact</a>; the touch of a hand, a smile, eye contact, and being able to take the time to genuinely listen. These actions are central to how nurses and other staff build effective and <a href="https://onlinelibrary.wiley.com/doi/10.1111/jan.12862" target="_blank" rel="noopener">meaningful relationships</a> with residents. Seeking to replace human contact with virtual interfaces seems both inconsistent with the Royal Commission’s findings and possibly cruel. Personal interactions also help staff, as the <a href="https://agedcare.royalcommission.gov.au/sites/default/files/2021-03/final-report-volume-1_0.pdf" target="_blank" rel="noopener">Royal Commission</a> highlighted: <blockquote> Knowing those they care for helps care staff to understand how someone would like to be cared for and what is important to them. It helps staff to care – and to care in a way that reinforces that person’s sense of self and maintains their dignity. This type of person-centred care takes time. </blockquote> Rather than circumventing reforms to ensure more nurses provide face-to-face care in nursing homes, we need to address the range of challenges contributing to widespread and tenacious <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/1467-8462.12427" target="_blank" rel="noopener">workforce shortages</a>. There are clear challenges for growing and retaining a sufficiently sized and skilled aged care workforce. However, government reforms, such as better pay, mandated care time, and greater accountability and transparency regarding the use of funds all work together to make aged care a feasible and attractive sector to work in. This is one where staff are supported to provide the high quality and safe aged care all Australians deserve and where older people receive best practice, human care. This article originally appeared in <a href="https://theconversation.com/could-virtual-nurses-be-the-answer-to-aged-care-staffing-woes-dream-on-188215" target="_blank" rel="noopener">The Conversation</a>. Image: Shutterstock

Retirement Life

How nurses are changing the conversation around medicinal cannabis

For many years, those with chronic conditions and ailments have had limited options for pain-relieving treatments, with varying opioids and anti-inflammatories the usual go-to for relief. However, in recent years the use of medicinal cannabis in Australia has <a href="https://www1.racgp.org.au/newsgp/clinical/research-shows-medicinal-cannabis-boom-in-australi">increased</a> exponentially, giving patients a new lease on life. While more people are turning to this natural source of treatment, accessing medicinal cannabis is still not easy. This accessibility issue has prompted the Australian Nursing and Midwifery Federation (ANMF), which has more than 310,000 members, and NSW and QLD nurse associations to lobby for medicinal cannabis education to be introduced into the curriculum for all schools of nursing and midwifery in Australia, so they can administer in hospitals. For former Queensland nurse Lucy Haslam, the accessibility and affordability is a cause close to her heart, as she saw first-hand how medicinal cannabis helped her son, Dan, during his battle with stage 4 bowel cancer. For me personally, medicinal cannabis is a topic I have been interested in for years. As a patient with a chronic condition with very limited treatment options, the accessibility hurdle is one I have long been fighting to jump over. However, to long-term pain patients like myself, this new initiative by the ANMF is bringing newfound hope that accessibility and affordability is at the forefront of the medicinal cannabis conversation. Australian Natural Therapeutic Group (ANTG) Chief Scientific Officer Justin Sinclair said this will be a game-changer for patients, as nurses are on the frontline of care with close relationships with patients. This comes as new <a href="https://www.aihw.gov.au/reports/illicit-use-of-drugs/australias-attitudes-and-perceptions-towards-drugs/contents/about">data</a> from the Australian Institute of Health and Welfare shows almost half the population support legalising cannabis, given its recent boom in success for treating patients with both physical and mental conditions. According to Justin Sinclair, medicinal cannabis is being used to treat a variety of conditions with outstanding results. He told OverSixty, “According to data from the Therapeutic Goods Administration, the main clinical indication that medicinal cannabis is being used for in Australia is chronic pain, with over 115,000 prescriptions being issued to date.” “That being said, there are a wide range of other clinical indications that Australian patients are also using medicinal cannabis for, and includes examples such as anxiety, sleep disorders, migraine, fibromyalgia, epilepsy, palliative care, multiple sclerosis and cancer pain and symptom management.” For many patients with a chronic condition, overuse of traditional pain-relievers can lead to more complex health issues, which can, in some circumstances, make medicinal cannabis a safer long-term solution. When it comes to the difference between medicinal cannabis and traditional pain-relievers, Dr Joel Wren, who is the President of the Society of Cannabis Clinicians Australian Chapter (SCCAC), believes medicinal cannabis is a superior option. He told OverSixty, “The significant differences of medicinal cannabis compared to other treatments is twofold; firstly it can be a multi-target medicine helping not only with pain, but possibly also sleep and anxiety all at the same time.” “The second difference is the variability; cannabis contains hundreds of botanical compounds which may contribute to the therapeutic benefits in different ways. Another huge difference is safety - there have been NO lethal overdoses on record that have ever been attributed 100% to cannabis.” As the ANMF and the Australian Medicinal Cannabis Association (AMCA) continue to campaign for wider distribution of medicinal cannabis, along with making the drug more affordable for those in need, Dr Joel Wren told OverSixty that patients should talk to their doctor about trialling medicinal cannabis through the current pathways. He said, “Australian patients need to speak with their doctor about possibly getting a prescription for medicinal cannabis. There has to be a clear medical reason, and conventional therapies and medications must be trialled first. If the doctor is confident, they can prescribe or alternatively they may refer to another doctor who can.” Image credits: Getty Images

Body

Terminally ill nurse caught in desperate waiting game

A nurse who has months to live as a result of her diagnosis of motor neuron disease (MND) is “virtually paralysed” and waiting for the NSW government to decide how she will die. Sara Wright had been a nurse for 33 years before she was diagnosed with amyotrophic lateral sclerosis (ALS) - a subtype of MND - two years ago, and is now dependent on a carer 24 hours a day. “The disease started as a weakness in my right foot, travelled up my right leg, then my left foot and leg,” the 54-year-old told <a href="https://7news.com.au/news/public-health/virtually-paralysed-nurse-waits-for-nsw-parliament-to-decide-how-she-will-die-c-6699939">7NEWS.com.au</a>. “Then it travelled up my torso affecting my upper body, firstly my abdominal muscles, and now it affects both of my arms and hands, my lungs and my swallowing and speaking muscles.” Ms Wright, who shared her story via dictation since speaking is difficult and painful, is waiting to see whether voluntary assisted dying laws (VAD) will be passed in the NSW Upper House next week. If they don’t pass, she says she will likely “have to deal with suffocating or choking to death”. “It’s a terminal illness and the average life expectancy is three to five years,” she explained. “Given I have already been living with the disease for three years, and the progression has been faster than I ever could have expected, I don’t know how long I will live. “I don’t think that I will live for more than another six to eight months, as my breathing capacity is reducing very fast and I do not wish to have a tracheostomy (an operation where a breathing hole is cut into the front of the neck and windpipe).” ALS/MND is more common among adults aged between 40 and 70 years, with 384 people diagnosed each day according to the <a href="https://www.als-mnd.org/what-is-alsmnd/" target="_blank" rel="noopener">International Alliance of ALS/MND Associations</a>. Ms Wright’s career as a nurse made her all too aware of the “limitations of palliative care in the final stages of terminal illness”, so she initially planned to book into Dignitas, a non-profit organisation in Switzerland that offers a range of end-of-life services. But, the COVID-19 pandemic derailed her plan with the closure of international borders. She then considered moving interstate, where VAD is legal, but she worried about uprooting her 15-year-old daughter, Ester, from her home and friends, especially since most of their family is UK-based. “(Ester) is now 15 and she needs to have her community around her for support when I die,” she said. “Obviously this is an incredibly difficult conversation to have with your own child. “We have not specifically spoken about what could happen to me if the laws aren’t passed … but I have tried to assure her that family in the UK will fly out to be with her as soon as they can if I die unexpectedly.” Ms Wright’s fate is tied to the voluntary assisted dying bill, which passed through the NSW Parliament’s lower house last year and is legal or will soon be legal in <a href="https://end-of-life.qut.edu.au/assisteddying" target="_blank" rel="noopener">every other state</a> except NSW. “I know that all my family, my parents, my brothers, my ex-husband are all in support of voluntary assisted dying and helping me relieve my suffering,” she said. “But none of us want to break the law or risk anyone being imprisoned if they helped me.” Since the bill entered the upper house last March, it has been debated passionately and passed through a second reading stage last week. It has even divided the state’s core leadership, with Premier Dominic Perrottet opposing the bill in favour of improving palliative care and Health Minister Brad Hazzard supporting it - despite opposing euthanisia for 29 years. Ms Wright, a strong supporter of VAD laws, has been brought close to the death of others during her nursing career and said she was “pretty certain” that if members debating the bill had seen people die uncomfortable, drawn-out deaths like she had, they would support the bill. “I have seen far too many people, elderly people, in the middle of the night in a ward without anyone there to hold their hand because nobody knew that was going to be their time to die,” she said. “I think that most people don’t think enough about death because we are all frightened of it. “And this could be the reason that some people are refusing to consider VAD laws, because it’s a topic that is deeply uncomfortable and taboo. “If we as a society were more mindfully aware and thoughtful about death, as it is the only certain outcome of life, then perhaps people would develop more compassion.” Though the laws could still be passed at some point if it fails to pass in next week’s final vote, Ms Wright said it would affect her whole family if it was too late for her to take advantage of it. “This will not only cause suffering to me but also to all of my family,” she said. “I wonder how many people have really stopped to think about what they would like, if they were in a position where they were going to die of (an) unpleasant and drawn-out death.” Image: 7News

Caring

Nurse who lost both legs to Russian landmine gets married in hospital

The first dance is a big moment for any bride and groom, but it was even more special for Oksana and Victor. Oksana lost both her legs on a Russian landmine in March, in their home town of Lysychansk, located in the Russian-occupied eastern Ukraine region of Luhansk. The explosion didn't injure Victor, although they were together at the time, but the bride lost both of her legs as well as four fingers on her left hand. Oksana underwent four surgeries and was later evacuated to Dnipro to recover and prepare for prosthetics, and eventually to Lviv, in the west near the Polish border. As she waited for the next part of the healing process, the couple, who have two children together, took the opportunity to wed in a Lviv hospital last week. “Life should not be postponed until later, decided Oksana and Victor, who in six years together never found time for marriage," Lviv Medical Association said, sharing video of the couple's special moment. <blockquote class="twitter-tweet"> ❤️🇺🇦 Very special lovestory. A nurse from Lysychansk, who has lost both legs on a russian mine, got married in Lviv. On March 27, Victor and Oksana were coming back home, when a russian mine exploded. The man was not injured, but Oksana's both legs were torn off by the explosion. <a href="https://t.co/X1AQNwKwyu">pic.twitter.com/X1AQNwKwyu</a> — Verkhovna Rada of Ukraine - Ukrainian Parliament (@ua_parliament) <a href="https://twitter.com/ua_parliament/status/1521194382682202113?ref_src=twsrc%5Etfw">May 2, 2022</a></blockquote> The footage was also shared by Ukraine's Parliament, which wished the couple well in their new life together. The sweet dance shows the groom carrying his new wife in his arms as she buries her head in her husband's neck. The couple are said to have wed at a local registry office before the hospital reception took place. Oksana is set to travel to Germany for further treatment. Image: Twitter

Relationships

Ukrainian nurses care for surrogacy babies underground

A makeshift bomb shelter in the Ukrainian capital of Kyiv has become a temporary home for babies born to surrogate mothers whose new parents can’t enter the country to take them home. At least 20 babies - including some that are just a few days old - have been taken underground where they are well cared for by the many nurses from the surrogacy centre also stranded in the shelter, as reported by <a href="https://7news.com.au/news/conflict/surrogate-babies-wait-out-war-in-ukraine-c-6135483" target="_blank" rel="noopener">7News</a>. With Ukrainian troops fighting off Russian forces in Kyiv’s suburbs, it has become too dangerous for the nurses to travel between the shelter and their homes. “Now we are staying here to preserve our and the babies’ lives,” said Lyudmilia Yaschenko, a 51-year-old nurse. “We are hiding here from the bombing and this horrible misery.” <img src="https://oversixtydev.blob.core.windows.net/media/2022/03/surrogacy.jpg" alt="" width="1280" height="720" /> At least 20 surrogacy babies are being cared for in an underground bunker as the war rages on above them. Image: Getty Images Ms Yaschenko said they could leave the shelter for brief periods to get some fresh air, but that they worked constantly to look after the children. “We are almost not sleeping at all,” she said. “We are working around the clock.” She also worried for her two sons - aged 22 and 30 - who were fighting to defend the country. Ukraine is one of the few countries that allows foreigners to use surrogate services, with <a href="https://www.bbc.com/news/world-europe-60824936" target="_blank" rel="noopener">most</a> of the 2000 children born through surrogacy every year are matched to foreign couples from Europe, Latin America and China. Though Ms Yaschenko wouldn’t say how many children are still waiting to be united with their parents or how many surrogate mothers are expected to deliver soon, the nurses have plenty of food and baby supplies to continue caring for them as they wait for the war to end. Image: Getty Images

Caring

Trainee nurse sprints into action to save toddler

A trainee nurse on his way to work has been hailed a hero after jumping into action and saving a toddler. Nicholas Jensen did not think twice when he heard a mother screaming for someone to help her two-year-old daughter who was turning blue and foaming from the mouth. The 44-year-old nurse grabbed the motionless toddler and placed her in the recovery position before rushing to the Princess Alexandra Hospital emergency room in Brisbane. CCTV from the hospital carpark captured the heroic moment he ran to the hospital with the girl’s mother following behind. Inside, he is seen running through the emergency department where he is directed by a fellow nurse through a door where he is met by seven other nurses. They rush him into a room where the toddler is placed on a bed and resuscitation begins to save the child. The nurses saved the toddler’s life and found she had suffered an atypical febrile convulsion which can be caused by a viral infection and fever, <a href="https://7news.com.au/news/qld/incredible-moment-trainee-nurse-saves-motionless-toddler-in-brisbane--c-6007072" target="_blank" rel="noopener">7News</a> reported. Doctors ordered the toddler to stay for two days for observation and is now doing well, thanks to Nicholas’s quick thinking. “In the moment adrenalin and my training kicked in,” he said. “This is why I got into this job, great job satisfaction. It is a meaningful career.” Images: 7News

Caring

“The status quo can’t continue”: Nurses striking for first time in a decade

Thousands of nurses in NSW public hospitals will <a href="https://au.news.yahoo.com/nsw-nurses-vote-statewide-strike-221536766.html" target="_blank" rel="noopener">go on strike</a>, as frustrations over understaffing, pay and working conditions prompt the first industrial action in almost a decade.Though votes are still underway in some branches, the NSW Nurses and Midwives’ Association (NSWNMA) says a majority have endorsed the industrial action.The union, which represents 48,000 nurses across the state’s public hospitals, says nurses will take part in a statewide strike for up to 24 hours on Tuesday, while skeleton staff will remain to care for the critically ill and preserve life.“We don’t recommend industrial action lightly, especially when a pandemic is still underway, but the status quo can’t continue,” NSWNMA General Secretary Brett Holmes said on Wednesday.“We can’t return to pre-COVID-19 staffing levels when we were already in crisis.”Sydney’s Royal Prince Alfred Hospital is considering a full-day strike, while nurses at Westmead and Cumberland hospitals will likely strike for 12 hours.<img src="https://oversixtydev.blob.core.windows.net/media/2022/02/nurse-strike.jpg" alt="" width="1280" height="720" />ICU nurses from Westmead Hospital protest, demanding the government address staffing levels. Image: NSW Nurses and Midwives’ AssociationThe strike on February 15 will also coincide with widespread rallies across the state, with locations including Newcastle, Tamworth, Bathurst, Bega and Lismore.It is the first statewide protest since 2013, as hospitals remain on high alert during the pandemic and face staff furloughs as their COVID-19 patient load stays high.The union is primarily asking that the government follow in the steps of Queensland and Victoria by implementing nursing and midwifing staffing ratios.“If the premier wants a well-staffed, well trained and resilient nursing and midwifery workforce in the public health system, then he must act now and implement shift by shift ratios across NSW,” Mr Holmes said.The union is also asking for a fair pay rise, higher than the 2.5 percent offered by the government, as well as for COVID-19 workers’ compensation to remain unchanged.The latter demand comes as the government seeks to scrap an automatic presumption under workers’ compensation rules that essential workers were infected with the virus at work.If the assumption is successfully removed, doctors, nurses, paramedics, teachers, supermarket workers and other essential workers will need to prove they caught COVID-19 at work, which unions say is virtually impossible.Image: NSW Nurses and Midwives’ Association

News

Conflicts between nursing home residents are often chalked up to dementia – the real problem is inadequate care and neglect

Frank Piccolo was a beloved high school chemistry teacher in Ontario, Canada, until his retirement in 1998. “His trademark was to greet all of his students at the door at the start of class to make sure everyone felt welcomed there,” <a href="https://www.saultstar.com/2013/02/21/remembering-frank-piccolo--oconnor">wrote a former student</a>. “He had extensive knowledge of his subject matter, passion for his craft, and empathy for his students.” But after Frank’s retirement, he developed dementia. When his condition declined, his family moved him to a Toronto nursing home. One evening in 2012, another resident – a woman with dementia – entered Frank’s bedroom. She hit Frank repeatedly in the head and face with a wooden activity board. Staff found Frank slumped over in his wheelchair, drenched in blood. He died three months later. The Ontario Ministry of Health and Long-Term Care investigated. It found that the woman had a history of pushing, hitting and throwing objects at staff and other residents. But the nursing home didn’t address the woman’s behavioral expressions for weeks before the attack on Piccolo, <a href="https://s3.documentcloud.org/documents/21048374/inspection-report.pdf">the agency determined</a>. “There were no interventions implemented, no strategies developed,” the report stated. <img src="https://images.theconversation.com/files/440940/original/file-20220115-27-vtyb52.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" alt="Frank Piccolo and his wife, Theresa, standing near each othe, on vacation, with a hillside village and the sea behind them." /> Frank Piccolo and his wife, Theresa, traveling together in Italy in 2001. Theresa Piccolo, <a href="http://creativecommons.org/licenses/by-nc-nd/4.0/" class="license">CC BY-NC-ND</a> As a gerontologist and <a href="http://dementiabehaviorconsulting.com">dementia behavior specialist</a>, I’ve <a href="https://www.healthpropress.com/product/understanding-and-preventing-harmful-interactions-between-residents-with-dementia/">written a book</a> on preventing these incidents. I also co-directed, with dementia care expert Judy Berry, a documentary on the phenomenon called “<a href="https://terranova.org/film-catalog/fighting-for-dignity-a-film-on-injurious-and-fatal-resident-to-resident-incidents-in-long-term-care-home">Fighting for Dignity</a>.” The film sheds light on the emotional trauma experienced by family members of residents harmed during these episodes in U.S. long-term care homes. <h2>Reporting and stigmatizing</h2> <a href="https://doi.org/10.1111/j.1532-5415.2008.01808.x">Resident-to-resident incidents</a> are defined by researchers as “negative, aggressive and intrusive verbal, physical, material and sexual interactions between residents” that can cause “psychological distress and physical harm in the recipient.” These incidents <a href="https://doi.org/10.7326/M15-1209">are prevalent</a> in U.S. nursing homes. But they are <a href="https://www.statnews.com/2021/11/29/resident-to-resident-incidents-hidden-source-nursing-home-harm/">largely overlooked</a> by the Centers for Medicare and Medicaid Services, the federal agency overseeing care in approximately 15,000 nursing homes across the country. Consequently, such incidents <a href="https://doi.org/10.1080/08946566.2017.1333939">remain untracked</a>, <a href="https://doi.org/10.1016/j.jamda.2015.10.003">understudied</a> and largely unaddressed. <a href="https://images.theconversation.com/files/440941/original/file-20220115-18-1qy7een.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/440941/original/file-20220115-18-1qy7een.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" alt="An elderly man with severe injuries, including cut marks and bruises, across his face and forehead." /></a> Frank Piccolo sustained severe injuries to his face and head after a woman with dementia entered his bedroom and hit him repeatedly with an activity board. Theresa Piccolo, <a href="http://creativecommons.org/licenses/by-nc-nd/4.0/" class="license">CC BY-NC-ND</a> These interactions don’t just result <a href="https://doi.org/10.1001/jama.291.5.591">in injuries</a> <a href="https://doi.org/10.1177/0733464819863926">and deaths</a> among residents. They also leave behind devastated families who then must <a href="https://www.washingtonpost.com/business/2021/08/20/nursing-home-immunity-covid-lawsuits">fight for answers</a> and accountability from nursing homes. Making matters worse, <a href="https://www.gao.gov/products/gao-19-433">government reports</a>, <a href="https://doi.org/10.1017/S0714980815000094">research studies</a> and <a href="https://doi.org/10.1177/1471301220981232">media coverage</a> commonly describe these episodes with words that stigmatize people with dementia. Researchers, public officials and journalists tend to <a href="https://www.startribune.com/when-senior-home-residents-are-abusers-minnesota-rarely-investigates/450625693/">label the incidents as “abuse</a>,” “violence” and “aggression.” They call a resident involved in an incident a “perpetrator” or an “aggressor.” News outlets described the attack on Piccolo by the woman with dementia as “aggressive” or “violent.” And when reporting on <a href="https://www.thestar.com/news/gta/2013/02/09/more_than_10000_canadians_abused_annually_by_fellow_nursing_home_residents.html">the phenomenon</a> in Canada, the Toronto Star called it “abuse.” <h2>Getting to the root of the real problem</h2> Most incidents, however, do not constitute abuse. A growing body of evidence suggests the true cause of these injuries and deaths is inadequate care and neglect on the part of care homes. Specifically, there is a lack of the specialized care that people with dementia require. Two of every three residents <a href="https://doi.org/10.1016/j.jamda.2021.02.009">involved in these incidents</a> have dementia. One study found that the rate of these episodes was nearly <a href="https://doi.org/10.1001/jama.291.5.591">three times higher</a> in dementia care homes than in other long-term care homes. A recent study also found <a href="https://doi.org/10.7326/m15-1209">an association</a> between residency in a dementia care home and higher rates of injurious or fatal interactions between residents. But for these residents, the conflicts occur mostly when their emotional, medical and other needs are not met. When they reach a breaking point in frustration related to the unmet need, they may push or hit another resident. My research in the U.S. and Canada has shown that <a href="https://doi.org/10.1080/08946566.2018.1474515">“push-fall” episodes</a> constitute nearly half of fatal incidents. Another U.S. study found that as residents’ cognitive functioning declined, they faced <a href="https://doi.org/10.1001/jama.291.5.591">a greater likelihood</a> of injury in these incidents. Those with advanced dementia were more susceptible to inadvertently “getting in harm’s way,” by saying or doing things that trigger angry reactions in other residents. The Centers for Disease Control and Prevention has stated that what it calls “aggression” between residents <a href="https://www.cdc.gov/violenceprevention/pdf/ea_book_revised_2016.pdf">is not abuse</a>. Instead, the CDC noted that these episodes may result when care homes fail to prevent them by taking adequate action. And a study on <a href="https://doi.org/10.1177/0733464819863926">fatal incidents</a> in U.S. nursing homes has shown that many residents were “deemed to lack cognitive capacity to be held accountable for their actions.” <iframe width="440" height="260" src="https://www.youtube.com/embed/gk5iEo-s_6M?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe> An undercover yearlong investigation into nursing homes in Ontario, Canada, revealed shocking instances of abuse and neglect by staff members. <h2>How incidents often occur</h2> In one study, researchers examined <a href="https://doi.org/10.1177/1054773813477128">situational triggers</a> among residents with cognitive impairments. The strongest triggers involved personal space and possessions. Examples include taking or touching a resident’s belongings or food, or unwanted entries into their bedroom or bathroom. The most prevalent triggering event was someone being too close to a resident’s body. That study also found that crowded spaces and interpersonal stressors, such as two residents claiming the same dining room seat, could lead to these episodes. <a href="https://doi.org/10.1177/1471301213502588">My own work</a> and a different <a href="https://doi.org/10.1177%2F0733464820955089">Canadian study</a> came to similar conclusions. Other research shows that when residents are bored or lack <a href="https://doi.org/10.1177%2F153331750502000210">meaningful activity</a>, they become involved in <a href="https://doi.org/10.1177%2F1471301213502588">harmful interactions</a>. Evenings and weekends can be particularly dangerous, with fewer organized activities and fewer staff members and managers present. <a href="https://doi.org/10.1080/08946566.2018.1474515">Conflicts between roommates</a> are also common and harmful. <img src="https://images.theconversation.com/files/438566/original/file-20211220-49721-z6ev8m.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" alt="With a smiling staff member looking on, two nursing home residents enjoy conversation while having coffee." /> Residents with dementia who are meaningfully engaged in activities are less likely to become involved in harmful incidents with other residents. <a href="https://www.gettyimages.com/detail/photo/caretaker-with-senior-people-in-nursing-home-royalty-free-image/489582967?adppopup=true" class="source">Morsa Images/DigitalVision via Getty Images</a> A growing body of research suggests that most incidents between residents are preventable. A major risk factor, for example, is lack of adequate supervision, which often occurs when staff are assigned to caring for too many residents with dementia. One U.S. study found that <a href="https://doi.org/10.7326/M15-1209">higher caseloads</a> among nurses’ aides were associated with higher incident rates. And with <a href="https://doi.org/10.4137/hsi.s38994">poor staffing levels</a> in up to half of U.S. nursing homes, <a href="https://doi.org/10.1080/08946566.2018.1474515">staff members do not witness</a> many incidents. In fact, one study found that staff members missed the majority of unwanted <a href="https://doi.org/10.1080/13607863.2016.1211620">bedroom entries</a> by residents with severe dementia. <h2>Residents with dementia are not to blame</h2> In most of these situations, the person with dementia does not intend to injure or kill another resident. Individuals with dementia live with a serious cognitive disability. And they often must do it while being forced to share small living spaces with many other residents. Their behavioral expressions are often attempts to cope with frustrating and frightening situations in their social and physical environments. They are typically the result of unmet human needs paired with cognitive processing limitations. Understanding the role of dementia is important. But seeing a resident’s brain disease as the main cause of incidents is inaccurate and unhelpful. That view ignores external factors that can lead to these incidents but are outside of the residents’ control. Frank’s wife, Theresa, didn’t blame the woman who injured her husband or the staff. She blamed the for-profit company operating the nursing home. Despite its revenue of $2 billion in the year before the incident, it failed in its “<a href="https://www.thestar.com/news/gta/2013/02/09/more_than_10000_canadians_abused_annually_by_fellow_nursing_home_residents.html">duty to protect</a>” Piccolo. “They did not keep my husband safe as they are required to do,” she said.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important; text-shadow: none !important;" src="https://counter.theconversation.com/content/173750/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/eilon-caspi-1298265">Eilon Caspi</a>, Assistant Research Professor of Health, Intervention, and Policy, <a href="https://theconversation.com/institutions/university-of-connecticut-1342">University of Connecticut</a> This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/conflicts-between-nursing-home-residents-are-often-chalked-up-to-dementia-the-real-problem-is-inadequate-care-and-neglect-173750">original article</a>. Image: CasarsaGuru/E+ via Getty Images

Retirement Life

Older Australians are already bamboozled by a complex home-care system. So why give them more of the same?

More than <a href="https://www.aihw.gov.au/reports/australias-welfare/aged-care">a million older Australians</a> need care at home each year. <a href="https://www.health.gov.au/sites/default/files/documents/2021/08/ninth-report-on-the-funding-and-financing-of-the-aged-care-industry-july-2021.pdf">More than 1,000 agencies</a> provide services to them. Despite the federal government allocating <a href="https://www.health.gov.au/initiatives-and-programs/aged-care-reforms/a-generational-plan-for-aged-care">significant extra funds to home care</a> in the last budget, there is still a raft of problems with current home-care arrangements. As we show in <a href="https://grattan.edu.au/report/unfinished-business-practical-policies-for-better-care-at-home/">our new report</a>, “Unfinished business: practical policies for better care at home”, the federal government is placing too much emphasis on expanding the market of services, and not enough on supporting people to access timely and quality services. Home care support ranges from help with personal care and cleaning the house, to provision of mobility aids, and transport to social events and medical appointments. People who need care at home can explore options via the federal government’s <a href="https://www.myagedcare.gov.au/">myagedcare</a> website. Then they can get assessed, find a local provider to suit their needs, and manage their own care. But this system is <a href="https://www.ingentaconnect.com/contentone/tpp/ijcc/2020/00000004/00000003/art00006">impersonal and cumbersome</a>. Assessment of people’s needs is divorced from planning their services. Older people get little advice and support to find services, and people who need more intensive and complex care often have to wait for more than a year. Administrative and coordination costs for the <a href="https://www.aihw.gov.au/reports/australias-welfare/aged-care">200,000 people who get home care packages</a> are high, hourly service charges are unregulated, and there is more than <a href="https://www.stewartbrown.com.au/images/documents/StewartBrown_-_ACFPS_Financial_Performance_Sector_Report_June_2021.pdf">A$1.6 billion in unspent funds</a> that could be used to provide services. The number of private services has grown dramatically, with little oversight of quality and value for money. At the same time, home-care workers <a href="https://www.smh.com.au/politics/federal/canberra-told-to-pay-up-to-get-aged-care-workers-a-25-per-cent-rise-20210705-p586x9.html">remain poorly paid and under-valued</a>. Training is patchy, work is often insecure, and there’s insufficient supervision, support and staff development. Not surprisingly, it is increasingly difficult to recruit and retain aged-care workers. <h2>What’s wrong with the extra funding?</h2> The federal government’s response to the landmark <a href="https://agedcare.royalcommission.gov.au/">Royal Commission into Aged Care</a> was substantial, but it doesn’t change the fundamentals of the home-care system. It expands a market that is not working for older people. The government is putting its faith in a centrally regulated market model, dominated by private and non-government home-care businesses. Even with the massively increased home-care funding, the market may still not provide enough to reduce waiting times for services to less than a month, as the royal commission recommended. <a href="https://images.theconversation.com/files/436568/original/file-20211209-137612-sxaiia.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img src="https://images.theconversation.com/files/436568/original/file-20211209-137612-sxaiia.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" alt="Elderly lady using laptop at home" /></a> Older people will still have to navigate a complex system and make market choices largely on their own. <a href="https://www.shutterstock.com/image-photo/asian-old-woman-using-computer-69690976" class="source">Shutterstock</a> There are currently almost <a href="https://gen-agedcaredata.gov.au/www_aihwgen/media/Home_care_report/Home-Care-Data-Report-1st-Qtr-2021-22.pdf">75,000 waiting for the home care support they need</a>, with some having waited up to nine months. We calculate that up to 15% more home-care places than planned could be needed just to clear the waiting list. We call on the federal government to keep waiting times to 30 days or less. The government’s budget package does include additional support to help older people navigate their way through the home-care system. But assessment, care finding, and care coordination will continue to be fragmented. In the main, older people will still have to navigate a complex system and make market choices on their own. <h2>We need to go local to provide the best support</h2> Australia needs a new home care model – one that provides much more personalised support to help older people get the services they need and that manages local service systems on their behalf. It’s difficult to see this being done without establishing effective regional aged-care offices. These offices need to provide a one-stop shop for older people. Yet they also need to have the authority and responsibility to develop and manage local services to make sure older people can get what they need. The federal government is aware of this problem, but its response is tepid – <a href="https://www.health.gov.au/sites/default/files/documents/2021/05/governance-pillar-5-of-the-royal-commission-response-strengthening-regional-stewardship-of-aged-care.pdf">a trial</a> of small, regional offices of up to ten people to plan, monitor and solve problems. But those regional offices have no responsibility for supporting older people, and no authority to manage service providers on their behalf. We recommend the federal government establish a network of regional aged-care offices across Australia to plan and develop services, hold funds, pay providers, and administer service agreements for individual older people who need care. These offices should include assessment teams and care finders, to help people who are trying to navigate the home-care system. Good quality home care depends on a well-qualified, secure and valued workforce. Again, the federal government is aware of this problem and has introduced a limited set of workforce reforms. But it has not yet agreed to support improved pay and conditions, minimum qualification standards or a full registration scheme for personal-care workers. The government should develop and implement a revitalised workforce plan for aged care as part of the <a href="https://www.health.gov.au/initiatives-and-programs/aged-care-reforms/aged-care-legislative-reform">new Aged Care Act</a>. Personal-care workers should be registered and hold suitable minimum qualifications. The government should also make it clear it will fund the outcomes of the <a href="https://www.fwc.gov.au/cases-decisions-orders/major-cases/work-value-case-aged-care-industry">Fair Work Commission</a> review of fair pay and conditions for aged-care workers, with a ruling expected next year. As Australia’s population continues to age, many more people with complex needs will need care. The vast majority of them will prefer to be supported at home. Massively expanding home-care services without much stronger market management, and a much more secure workforce, is a risk Australia shouldn’t take.<img style="border: none !important; box-shadow: none !important; margin: 0 !important; max-height: 1px !important; max-width: 1px !important; min-height: 1px !important; min-width: 1px !important; opacity: 0 !important; outline: none !important; padding: 0 !important; text-shadow: none !important;" src="https://counter.theconversation.com/content/173326/count.gif?distributor=republish-lightbox-basic" alt="The Conversation" width="1" height="1" /> <a href="https://theconversation.com/profiles/stephen-duckett-10730">Stephen Duckett</a>, Director, Health and Aged Care Program, <a href="https://theconversation.com/institutions/grattan-institute-1168">Grattan Institute</a> and <a href="https://theconversation.com/profiles/hal-swerissen-9722">Hal Swerissen</a>, Emeritus Professor, La Trobe University, and Fellow, Health Program, <a href="https://theconversation.com/institutions/grattan-institute-1168">Grattan Institute</a> This article is republished from <a href="https://theconversation.com">The Conversation</a> under a Creative Commons license. Read the <a href="https://theconversation.com/older-australians-are-already-bamboozled-by-a-complex-home-care-system-so-why-give-them-more-of-the-same-173326">original article</a>. Image: Shutterstock

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Older Australians are already bamboozled by a complex home-care system. So why give them more of the same?

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Hospice nurse shares what happens to the body after death

Hospice nurse shares the four physical stages of dying

Hospice nurse reveals the key to a peaceful death

What happens if you want access to voluntary assisted dying but your nursing home won’t let you?

Hospice nurse reveals six unexplainable "death bed phenomena"

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Conflicts between nursing home residents are often chalked up to dementia – the real problem is inadequate care and neglect

Older Australians are already bamboozled by a complex home-care system. So why give them more of the same?

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Life behind bars for serial killer nurse